Medicare : Member Materials

Thank you for being a WellCare member. On this page, you will be able to quickly find member materials, forms, flyers and brochures.

Plan Information and Materials

Enrollment Form

Evidence of Coverage

Summary of Benefits

Comprehensive Formulary and Formulary Updates

Plan Ratings

HealthStuff (Over-The-Counter) Catalog 

Routine Dental Brochure

Transportation Flyer (Advocate Complete Plan Flyer)

Low Income Subsidy (LIS) Premium Summary Chart

Explanation of Benefits (sample)  (Spanish)

Part D Transition Letter (sample) (Spanish)

Part D Transition Policy

Payment and Reimbursement Forms
 

WellCare Direct Member Reimbursement 

Electronic Funds Transfer

HealthStuff (Over-The-Counter) Item Reimbursement 

 

Authorization Forms

Appointment of Representative

HIPAA Release of Information 

HIPAA Release of Information Revocation 

 

Pharmacy and Other Forms

Exactus Pharmacy Solutions Enrollment Form

Exactus Pharmacy Solutions Prescription Order Form 

Online Form: Request for Medicare Prescription Drug Coverage Determination (Provider & Member)

Request for Medicare Prescription Drug Coverage Determination 

• Providers and members should fax form to 1-866-388-1767

WellCare Injectable Infusion

Online Form: Request for Redetermination of Medicare Prescription Drug Denial (Appeal)

Request for Redetermination of Medicare Prescription Drug Denial (Appeal) 

Medicare Prescription Drug Coverage and Your Rights

Last modified: 04/09/2012